Provider Demographics
NPI:1225503923
Name:PATKIN, SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PATKIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2745
Mailing Address - Country:US
Mailing Address - Phone:617-775-7076
Mailing Address - Fax:
Practice Address - Street 1:73 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2745
Practice Address - Country:US
Practice Address - Phone:617-775-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022440104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker